In Reply: Although patients with BAVs have a low risk of aortic dissection as a population,1 patients with aneurysms of 45 mm or larger have a higher incidence of dissection (0.45% per year) and must be followed up carefully.1 Nonetheless, this dissection incidence does not justify the risk of elective repair for all these patients,2 but we believe it justifies the current policy of elective repair in patients already undergoing aortic valve replacement with an ascending aorta dimension of 45 mm or larger.